File under: “I’m married to my illness and refuse to get better”

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Rated R for language.  And it’s long, so grab some tea or something.  You’ve been warned.

After days like today, it’s easy to surmise that all patients are psychotic.  After all, we’ve already established that all massage therapy clients are, so why not patients as well?  And although the simple majority of patients are nice, normal people who have chronic issues they genuinely need help with, occasionally you get one that makes you shake your head in a pitiful disbelief and wonder, “what the fuck?”

It wasn’t the first time I’ve seen this and I’ll bet every longhorn on the ranch it won’t be the last.  Without divulging too much info (OK, fine, I’ll divulge what is probably too much info), lady who wraps her head in towels (or scarves?  Not sure) shows up today with cocky and oh-so-witty supportive husband (a good sign) for the first follow-up visit.

My first clue was when my front desk assistant came back to my office in person to give me a “heads up” that in the grand scheme of Good Days and Bad Days our patients invariably experience–especially in the earlier stages of healing–this was definitely a Bad Day.

Fair enough; I was prepared.

The Black Wall of Poor Me hit me the minute I opened the door and the two minutes I waited in said doorway for them to finally get with the program.  A big show of  I’m Miserable slowly plodded down the hallway and then, in an unnerving fight for the alpha position, refused to sit like any normal patient, and immediately started in, pummeling me with complaints phrased as questions as though she were pretending to ask for help when really, she was trying to cover all her bases, hitting me with one paltry pathetic excuse after another as to why she cannot abide by a simple hypoallergenic diet and a few supplements for two whole weeks.  Yeah, and as exhausting as that sentence was to read, multiply that by about eight and you’ll understand my insatiable desire to *facepalm* right then and there.

Whether it’s the budget (but she won’t work to add to said budget), the restricted diet (that I have spelled out in detail, complete with suggestions, sample recipes, trusted internet resources, and FAQs Just Like Hers), the requirement said patient placed on herself to only buy in-season produce (which is not a requirement I would place on a patient), and a lengthy and arbitrary list of myriad foods she “won’t eat” (hello, have we spent the past 35-odd years having reached only the developmental milestones of a six-year-old?), there were only about 5 foods left on the list that met all the ridiculous criteria and, unsurprisingly, we were getting tired of them.

And then there were the irrational rules that she set for herself.  She wouldn’t eat anything unless she cooked it herself, but since she spends about 5 out of every 7 days in bed, she can cook for herself but about twice a week, if she’s lucky.  Now, either she’s totally exaggerating, she has the digestive transit time of a snail, she’s leaving out a detail or two, or one of us (her or myself) doesn’t understand basic concepts of time and/or math, her memory is warped, or the laws of physics twist themselves into pretzels in her presence.  Yeah, I’m with you: I’m going with insane, too.

I unquestionably spelled out a few cold hard realities that are beyond escape, and bit by bit, I started with the smallest, most palatable baby step toward embracing these realities.  And just as fast as I brought them up, I Refuse To Sit And Instead I Will Stand Opposite You And Tower Over You shot them down.  I can’t afford it.  (Stick with the Clean 15.) I can’t do berries.  (OK, pick something else.  Lots on the list to choose from!)  I won’t eat [insert most foods on the list here].  I don’t even really like apples (–wait…what kind of sick dementia candidate doesn’t like apples?  You’ve crossed a line; can’t help ya there.  No really–you’ve crossed a line.)

Oh and all those educational handouts that I painstakingly created, printed, and assembled on a fucking weekend?  “They didn’t help at all.”  Really?  OK, she wrote on her test results, so I’m sure she read the material I’d given her.  Maybe we’re a little deficient in the reading comprehension department?  Believe me, it wouldn’t be the only deficit in this situation.  In the meantime, talk about a little slap in the face, eh?  Hell I should’ve said, “alrighty then” and taken them back then and there, to save for someone more appreciative.

I finally looked at her and said, “I’m here for you.  What would you like me to do?”

Lamely (picture a two-year-old stamping its feet) she whined, “I don’t know.”

(Well then, why not take maybe ONE of the fifty fucking solutions I’ve thrown out?  It’s a pathetic dumbass who shoots down every solution without offering any of their own.)

Finally I summoned reinforcements, i.e. my other half, who went in and talked with…not the patient.  The patient had already gotten up and left–walked out, at the Supportive Husband’s insistence.  What surprised me was, the husband was not experiencing an Unsupportive Moment; it’s not that he wanted her to discontinue care at our office.  Nope, it’s because at that moment, he realized it was hopeless.  My partner told me later that the husband told the patient that if she can’t do what the doctor tells her to do, we “might as well leave and stop wasting their time”.  The impatient exasperation I had felt thickly emanating from him while I went round and round with his wife was actually directed not at me, but at her.  After all, he had shelled out Big Bucks to help her solve and overcome symptoms of chronic sickness she had complained of for years, through which he has stuck beside her since Day One.  As a Stay-At-Home (SAHM=SHAM, in this case) Moomie, she didn’t contribute one iota to said funds flushed down her personal toilet on her behalf.

I say “flushed” because that’s exactly what happened.  There she sat, with undeniable test results backing up her symptoms, giving her credibility and legitimacy, in the care of a doctor who was going to listen, take her seriously, and go to the ends of the earth to figure out her problem, and a carefully constructed plan, of sound logic and very hopeful results.  And next to her sat a husband who had been with her through thick and thin, supporting her, accepting her, nurturing her, loving her anyway, who was now watching her throw a toddler-level temper tantrum in my office, stubbornly refusing to eat practically ANY foods on my long and generous list.

How hopeless.  And how embarrassing.  (For him.  And whether or not she realizes it, for her too.)

After the dust had settled and they had gone, I double-checked the file.  In hindsight, clues were everywhere.  Drama-queen.  Attention-whore.  Prescription painkiller addict.  Oh yes, it was all there, kind of.  She’s not a special snowflake, either; I’ve personally dealt with other patients exactly like her, with the same attitudes, the same opiate scrips from other doctors, the same cushy lifestyle, the same lame excuses, and the same unsuccessful outcomes, despite my throwing my head against the wall to try and help her–yes, help her, even through my own frustration.

Yes, I judge this patient.  Yes, I harshly criticize her.  I’m not sorry for that and I won’t take it back.  I don’t care who casteth the first stone and shit; if you’re thinking about judging me for judging this patient’s actions, then you need to walk a mile in my shoes.  Because I have walked a mile in hers.  I, too, had a shit-ton of nonspecific, mysterious, and aggravating symptoms that freaked me out, slowly took away my freedom and abilities, and slowly sucked away my spirit.  Desperately, I sought out help from anyone I could.  Had I heard then of the approach I use now, I would’ve jumped on it like a pack of Greyhounds.  I would’ve killed (or at least maimed) for an opportunity like this.  And to have a husband working his ass off to support me and to have the means to find the funds for this kind of approach to boot, well, that would’ve been very useful to me about 5-7 years ago when I was beginning to crack.  This Martyr Complex doesn’t know how lucky she has it.  I have indeed cried and prayed for such a doctor and opportunity; when it didn’t come (that’s right: it NEVER came), I knew I had to become that doctor myself.  Hello several more years of self-abuse as I went through more school.

And sadly, I’ve seen this kind of thing before.  Patients with problems (some perfectly genuine, others semi-exaggerated, and a few downright fake) seek help at our office.  They submit to our battery of labs and analysis, a lengthy report of findings in which we review the test results and the findings they indicate, and then a fairly intensive care plan involving plenty of fundamental lifestyle modification and supplements.

For most, this process goes just fine, but for a prominent few, their condition has–consciously or not–intertwined itself with their very being, becoming such a defining part of their lives that it’s actually stressful–or even painful–to let it go.  More often than not, this is the result of Fringe Benefits these folks get when they’re chronically sick and miserable.  Think about such a Benefits Package – 1) Nothing is expected of them.  They don’t have to work; they will be readily supported by their spouse/partner.  2) Again, nothing is expected of them; they get out of housework, childcare, and sex.  3) They exert control over those around them through manipulation via pity; everyone around them is compelled to feel sorry for them.  4) They constantly demand–and receive–attention unto themselves, always remaining in the spotlight and constantly receiving recognition for any menial task they do accomplish.

Make zero mistake – I understand perfectly well that there are genuine sick people out there who desperately need help and would do anything to get it.  And these people, perfectly sane, would seize that treatment plan drawn up just for them and take it by the horns, looking forward to each step of getting better and truly healing.  By and large, most patients deserve all of the compassion, attention, respect, and dignity that can ever be given them.  However, there are some whackjobs out there who, as tough as it may be to fathom, think nothing of wasting their spouse’s dough on yet another wild goose chase that WOULD have been promising if only they had any intention at all of seeing it through.

I’m not for one second going to claim that I’m somehow a better person than this woman, because who’s to say?  It’s not my place; I’d be obviously biased and possibly incorrect.  However, I will point out that we are both “sick”, so to speak; we both face similar struggles in life, dealing with bodies that won’t cooperate, no matter how hard we try.  The difference between us is that I am (at least mostly, save for some bipolarity and right-cortical hemisphericity) mentally healthy and she is mentally/emotionally…not.  Far be it from me to diagnose her exact psychiatric problem, but what I know is this: if a mentally healthy person is physically sick, they’re going to do everything in their power that it takes to get well.  They don’t WANT to be sick.  Why?  Because they have all of their marbles!

The emotionally/mentally unstable person, however, actually has more to gain than to lose by staying sick.  So although they may pretend to want to get well (or maybe they actually think they want to get well) when push comes to shove and their feet are held to the fire, they end up clinging to their illness, their symptoms, and their label, to maintain the Benefits Package they’ve come to get used to.  Sadly, the Benefits Package is more important to them than having a meaningful, healthy relationship as a functional, healthy person.

Not that it’s my business, but I can’t help but think about the Come-To-Jesus meeting that most certainly should take place tonight if Supportive Husband has any ounce of emotional wellbeing/integrity.  Such a meeting should go, “honey?  All this time, I thought you were sick.  And all this time, I really thought you wanted to get better.  Today, I’ve seen that you don’t.  I deserve better.  The kids deserve better.  You deserve what you settled for.  But don’t expect me to be part of it any longer.  I’m done.  See ya.”

And frankly, that’d be the best thing for all of them.  He’d finally be free of the Head-Towel-Wrapped Parasite, the kids wouldn’t be subjected to a whiny headcase “role model” who stays in bed most of the time, and she might have to…I don’t know, grow up and oh, earn her own keep like an adult…and maybe add in a sixth or seventh approved fruit/vegetable.

Meanwhile?  I got to come home to a healthy, balanced relationship, a kick-ass dinner, a scrumptious smoothie, two cute little fur-kids, a sanitary apartment, and the knowledge that I will never (no matter how bad it gets) allow my physical health issues to define who I am and live in the hellish prison that I would thus be creating for myself.  Tonight, I’m not having to have any Come-To-Jesus meeting…unless it’s about changing out the empty toilet paper roll.

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